Evidence map›Paper›PMID 30686304›Full record

ArticleBritish journal of anaesthesia2019

Cardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study.

T E F Abbott, R M Pearse, B H Cuthbertson, D N Wijeysundera, G L Ackland, METS study investigators

Registry-linked trialOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07394647 (Transcutaneous Auricular Vagus Nerve Stimulation for Preventing Emergence Agitation and Delirium After Pediatric Tonsillectomy and Adenoidectomy), which is not on this map. Cited by 17 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 4 pooled it
2.2field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07394647 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Transcutaneous Auricular Vagus Nerve Stimulation for Preventing Emergence Agitation and Delirium After Pediatric Tonsillectomy and Adenoidectomy: A Randomized, Double-Blind, Interventional Study

TypeinterventionalSponsorThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityRan2026 to 2026Enrolled120ConditionsEmergence Agitation, Emergence DeliriumArmsActive taVNS Group, Sham stimulation group
3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 29 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 2 countries.

T E F AbbottWilliam Harvey Research Institute, Queen Mary University of London, London, UK; University College London Hospital, London, UK.
R M PearseWilliam Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
B H CuthbertsonDepartment of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
D N WijeysunderaUniversity of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Toronto General Hospital, Toronto, ON, Canada.
G L AcklandWilliam Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK. Electronic address: g.ackland@qmul.ac.uk.
METS study investigators
Queen Mary University of London · GBSunnybrook Health Science Centre · CAUniversity of Toronto · CA

Funding

British Heart Foundation RG/14/4/30736Department of Health RP_2014-04-022Medical Research Council MR/M017974/1
6 · The paper itself

Abstract

backgroundThe aetiology of perioperative myocardial injury is poorly understood and not clearly linked to pre-existing cardiovascular disease. We hypothesised that loss of cardioprotective vagal tone [defined by impaired heart rate recovery ≤12 beats min

methodsWe conducted a pre-defined, secondary analysis of a multi-centre prospective cohort study of preoperative cardiopulmonary exercise testing. Participants were aged ≥40 yr undergoing non-cardiac surgery. The exposure was impaired HRR (HRR≤12). The primary outcome was postoperative myocardial injury, defined by serum troponin concentration within 72 h after surgery. The analysis accounted for established markers of cardiac risk [Revised Cardiac Risk Index (RCRI), N-terminal pro-brain natriuretic peptide (NT pro-BNP)].

resultsA total of 1326 participants were included [mean age (standard deviation), 64 (10) yr], of whom 816 (61.5%) were male. HRR≤12 occurred in 548 patients (41.3%). Myocardial injury was more frequent amongst patients with HRR≤12 [85/548 (15.5%) vs HRR>12: 83/778 (10.7%); odds ratio (OR), 1.50 (1.08-2.08); P=0.016, adjusted for RCRI). HRR declined progressively in patients with increasing numbers of RCRI factors. Patients with ≥3 RCRI factors were more likely to have HRR≤12 [26/36 (72.2%) vs 0 factors: 167/419 (39.9%); OR, 3.92 (1.84-8.34); P<0.001]. NT pro-BNP greater than a standard prognostic threshold (>300 pg ml

conclusionsImpaired HRR is associated with an increased risk of perioperative cardiac injury. These data suggest a mechanistic role for cardiac vagal dysfunction in promoting perioperative myocardial injury.

Indexed as

Exercise ToleranceSurgical Procedures, OperativeAgedAged, 80 and overCohort StudiesExercise TestFemaleHeartHeart InjuriesHeart RateHumansMaleMiddle AgedNatriuretic Peptide, BrainPeptide FragmentsPostoperative ComplicationsNatriuretic Peptide, BrainPeptide Fragmentspro-brain natriuretic peptide (1-76)B-type natriuretic peptidecardiopulmonary exercise testingheart ratemyocardial injury after non-cardiac surgerysurgerytroponinvagal function

Identifiers

PMID30686304
PMCPMC6354047
OpenAlexW2904717953

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.